Anesthesiologists are raising alarm about an insurance company\u2019s plan to limit the amount time they cover for anesthesia used in surgeries and procedures. One major professional group of anesthesiologists is calling for immediate reversal of the \u201cunprecedented move,\u201d saying it\u2019s egregious and uninformed. <\/p>\n
Starting in February, Anthem Blue Cross Blue Shield insurance representing Connecticut, New York and Missouri will deny any claims for anesthesia services that exceed specific time limits that have been set for surgeries and procedures. <\/p>\n
Anthem said the change is part of an effort to make health care more affordable by reducing overbilling for anesthesia. <\/p>\n
The company said that the standards it\u2019s using to determine how long a surgery should last are consistent with industry standards and formulas set by the American Society of Anesthesiologists. Maternity-related care and pediatric services for patients younger than 22 will be excluded from this change, as there is more variability in the time needed for surgeries and procedures for these groups, Anthem said. <\/p>\n
But the American Society of Anesthesiologists has called for an immediate reversal of this policy, saying that Anthem has set an \u201carbitrary time limit\u201d on surgeries that threatens individual patient care. <\/p>\n
\u201cWith this new policy, Anthem will not pay anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention because their surgery is difficult, unusual or because a complication arises,\u201d the organization said in a news release. <\/p>\n
Anesthesiologists say that Anthem\u2019s new policy reflects a great misunderstanding of how things work in the operating room and adds a significant amount of undue strain to providers and patients. <\/p>\n
Dr. Gordon Morewood, vice chair for the American Society of Anesthesiologists\u2019 Committee on Economics, recently participated in a meeting between the society and Anthem executives. <\/p>\n
He said that experts tried to explain the way anesthesia billing works \u2014 that one specific billing code could be used for nearly 200 different procedures, leaving great variability in the amount of time needed under anesthesia \u2014 and learned that Anthem hadn\u2019t audited claims and didn\u2019t have any evidence that there was a problem that needed to be fixed. <\/p>\n
\u201cIt\u2019s a cynical exercise in figuring out a way to reject more claims initially, knowing that a number of those are just going to fall off and never be paid,\u201d Morewood said. <\/p>\n
It would be extremely difficult for anesthesiologists to bill for unnecessary time, especially in operating room settings where many detailed time stamps are recorded and with the help of automated electronic health records, experts say. <\/p>\n
Any additional time under anesthesia is usually related to ensuring that patients are safely cared for, such as securing a safe airway, or responding to physiologic changes that may occur because of the surgery, such as blood pressure or respiratory changes, said Dr. Rick van Pelt, a board-certified anesthesiologist and chief clinical transformation officer at the University of Alabama at Birmingham Hospital. <\/p>\n
\u201cThis approach (by Anthem) reflects a profound lack of understanding of the role of the anesthesiologist in providing safe, high-quality care to patients as an integral member of the surgical care team,\u201d he said. \u201cWhile no anesthesiologist would intentionally compromise on the care they provide, it is inevitable that unwarranted time pressure will increase the risk of adverse medical events and patient harm.\u201d <\/p>\n
Anesthesiology is often a top fear for surgical patients and adding uncertainty around insurance coverage threatens trust in a vulnerable moment, said Morewood, who is also chair and professor of clinical anesthesiology at Temple University\u2019s Lewis Katz School of Medicine. Reassuring patients about insurance concerns can take away from time spent explaining the risks and benefits of the actual medical care. <\/p>\n
\u201cOftentimes you\u2019re meeting your anesthesiologist on the day of surgery. And yet, this is someone in whom you are literally putting your life in their hands. They are responsible for your continued existence on this planet an hour, two hours, six hours from now. So that\u2019s a very charged environment,\u201d he said. \u201cTo have insurance companies saying, \u2018Okay, the meter is going to run out after an hour and a half\u2019 is just unconscionable.\u201d <\/p>\n
For surgeries and procedures that do require more time than Anthem has set, providers will be able to file a claim dispute. But that adds even more burden to the \u201carmy of people\u201d who work for providers to handle the \u201cpaperwork war\u201d with insurance companies, Morewood said \u2013 and that additional burden is more likely to affect health care costs that trying to trim down anesthesia times. <\/p>\n
\u201cHealth care delivery has numerous opportunities for improvement in quality, safety, and efficiency. The care environment is complex and there is a general lack of understanding of the interconnected systems that contribute to the problem,\u201d van Pelt said. \u201cOR efficiency cannot be solved by addressing any single component, and we know that working faster is not a sustainable solution.\u201d <\/p>\n<\/p>\n
Anesthesiologists are raising alarm about an insurance company\u2019s plan to limit the amount time they cover for anesthesia used in surgeries and procedures. One major professional group of anesthesiologists is calling for immediate reversal of the \u201cunprecedented move,\u201d saying it\u2019s egregious and uninformed. Starting in February, Anthem Blue Cross Blue Shield insurance representing Connecticut, New …<\/p>\n","protected":false},"author":1,"featured_media":1759,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"loftocean_post_primary_category":0,"loftocean_post_format_gallery":"","loftocean_post_format_gallery_ids":"","loftocean_post_format_gallery_urls":"","loftocean_post_format_video_id":0,"loftocean_post_format_video_url":"","loftocean_post_format_video_type":"","loftocean_post_format_video":"","loftocean_post_format_audio_type":"","loftocean_post_format_audio_url":"","loftocean_post_format_audio_id":0,"loftocean_post_format_audio":"","loftocean-featured-post":"","loftocean-like-count":0,"loftocean-view-count":639,"tinysalt_single_post_intro_label":"","tinysalt_single_post_intro_description":"","tinysalt_hide_post_featured_image":"","tinysalt_post_featured_media_position":"","tinysalt_single_site_header_source":"","tinysalt_single_custom_site_header":"0","tinysalt_single_custom_sticky_site_header":"0","tinysalt_single_custom_sticky_site_header_style":"sticky-scroll-up","tinysalt_single_site_footer_source":"","tinysalt_single_custom_site_footer":"0","footnotes":""},"categories":[35],"tags":[],"class_list":["post-1758","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-news"],"_links":{"self":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts\/1758","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/comments?post=1758"}],"version-history":[{"count":0,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts\/1758\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/media\/1759"}],"wp:attachment":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/media?parent=1758"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/categories?post=1758"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/tags?post=1758"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}